Aims/Introduction
To evaluate the annual direct medical cost attributable to type 2 diabetes mellitus according to socioeconomic factors, medical conditions and complications categories.
Materials ...and Methods
We created uniquely detailed data from merging datasets of the local diabetes management system and the social security system in Tongxiang, China. We calculated the type 2 diabetes mellitus‐related total cost and out‐of‐pocket cost for inpatient admissions and outpatient visits, and compared the cost for patients with or without complications by different healthcare items.
Results
A total of 16,675 patients were eligible for analysis. The type 2 diabetes mellitus‐related cost accounted for 40.6% of the overall cost. The cost per patient was estimated to be a median of 1,067 Chinese Yuan, 7,114 Chinese Yuan and 969 Chinese Yuan for inpatient and outpatient cost, respectively. The median total cost for hospital‐based care was 3.69‐fold higher than that for primary care. The median cost of patients with complications was 3.46‐fold higher than that of those without complications. The median cost for a patient with only macrovascular, only microvascular or both macrovascular and microvascular complications were 3.13‐, 3.79‐ and 10.95‐fold higher than that of patients without complications. Pharmaceutical expenditure accounted for 51.8 and 79.7% of the total cost for patients with or without complications, respectively.
Conclusions
Although the type 2 diabetes mellitus‐related cost per patient was relatively low, it accounted for a great proportion of the overall cost. Complications obviously aggravated the economic burden of type 2 diabetes mellitus. Proper management and the prevention of diabetes and its complications are urgently required to curtail the economic burden.
Type 2 diabetes mellitus‐related cost accounted for 40.6 % of the overall cost. The cost per patient was estimated to be 1,067 Chinese Yuan (CNY) in median, 7,114 CNY and 969 CNY at the median for inpatient and outpatient cost, respectively. The median total cost for hospital‐based care was 3.69 times higher than that for primary care. The median cost of patients with complications was 3.46 times higher than of those without complications, patients with only macrovascular, only microvascular, or both macrovascular and microvascular complications were 3.13 times, 3.79 times and 10.95 times higher than that of patients without complications. Pharmaceutical expenditure accounted for 51.8 and 79.7% of total cost for patients with or without complications, respectively.
Hypertension is a known risk factor for multiple chronic diseases. Existing literature on the association between frequency of spicy food consumption and hypertension shows mixed findings.
The ...analyses are based on the Tongxiang baseline dataset of the China Kadoorie Biobank prospective study, including data from electronic questionnaires, physical measurements and blood sample collection. A total of 53,916 participants aged 30-79 years were included in the final analysis. Multivariable logistic regression was used to estimate the association of spicy food consumption with hypertension, and multiple linear regression was performed to explore the association of spicy food consumption with systolic and diastolic blood pressure.
Of the 53,916 participants, 23,921 had prevalent hypertension. 12.3% of participants reported consuming spicy food weekly. Among female participants, after adjusting for socio-demographic status, lifestyle factors, BMI, waist circumference, sleep duration and snoring, when compared with females who never consumed spicy food, the odds ratios (95% CI) for hypertension were 1.02 (0.96-1.08), 0.90 (0.79-1.01), and 0.88 (0.78-0.99), respectively, for females who consumed spicy food less than once weekly, 1-2 times weekly, and ≥ 3 times weekly (P
= 0.04). The corresponding odds ratios for males were 1.02 (0.95-1.09), 1.07 (0.95-1.20), and 0.91 (0.81-1.01), respectively (P
= 0.39). Among current alcohol drinkers, compared to participants who never consumed spicy food, the odds ratio (95% CI) for hypertension among participants consuming spicy food daily was 0.98 (0.80-1.20). The corresponding figure for non-current drinkers was 0.72 (0.62-0.84). The association was stronger among non-current alcohol drinkers than among current drinkers (P
= 0.02).
Frequency of spicy food consumption is inversely associated with hypertension in females, but not in males.
Previous studies, mostly of Western women, have reported inconsistent findings on the association of menopause characteristics (status, age, and time since menopause) and total reproductive years ...with risk of cardiovascular disease (CVD).
The China Kadoorie Biobank recruited 302 632 women in 2004 to 2008 from 10 regions across China. During 9-year follow-up, 19 393 incident cases of stroke, 18 611 of ischemic heart disease, and 4978 CVD deaths occurred. Cox regression yielded adjusted hazard ratios relating each menopause characteristic and total reproductive years to CVD risk. Among 274 233 women with no prior CVD at baseline, 134 010 were naturally postmenopausal women (mean SD age at menopause of 48.6 4.0 years and total reproductive years 32.7 4.4). Compared with premenopausal women, naturally peri- or postmenopausal women were at a higher risk of either fatal or nonfatal CVD. Among women who had had menopause, inverse associations were observed between age at menopause and risks of CVD mortality, incident ischemic heart disease, stroke, and subtypes of stroke, with 1.5% higher risk of CVD death (
<0.001), 0.7% for incident ischemic heart disease (
=0.002), and 0.5% for incident stroke (
=0.02) for every 1 year lower age at menopause. Compared with women who had menopause at age 48 to 50 years, lower age at menopause (ie, <43 years) was associated with 14% higher risk of CVD death and 6% higher risks of both incident ischemic heart disease and stroke. Higher risks of both fatal and nonfatal CVD were also found in women with 5 to 10, 10 to 15, 15 to 20, or >20 years since menopause compared with <5 years since menopause. Total reproductive years were inversely associated with risks of both fatal and nonfatal CVD, with 1.4% lower risk of CVD death per additional reproductive year (
<0.001).
Women with younger age at menopause, longer time since menopause, or fewer total reproductive years had a higher risk of CVD.
Hypertension, a well-known risk factor, contributes to millions of deaths from cardiovascular and renal diseases worldwide. However, evidence on the association between frequency of dairy product ...consumption and hypertension is inconsistent.
The data for the present study are from the Tongxiang baseline dataset of the China Kadoorie Biobank prospective study. A total of 53,916 participants aged 30-79 years were included in the final analysis. Multivariable logistic regression was utilized to evaluate the association of dairy product consumption with hypertension, and multiple linear regression was conducted to assess the association of dairy product consumption with systolic and diastolic blood pressure.
Of the 53,916 participants, 2.6% reported consuming dairy products weekly, and 44.4% had prevalent hypertension. After adjusting for socio-demographic status, lifestyle factors, BMI, waist circumference, sleep duration and snoring, when compared with participants who never consumed dairy products, the odds ratios (95% CI) for hypertension among those consuming dairy products less than once per week, and ≥ 1 time per week were 0.85 (0.77-0.95) and 0.74 (0.65-0.84), respectively. The corresponding odds ratios (95% CI) for men were 0.85 (0.71-1.02) and 0.75 (0.61-0.92), respectively (P
= 0.001), and for women were 0.88 (0.76-1.01) and 0.77 (0.65-0.91), respectively. (P
< 0.001).
In this large epidemiological study, higher frequency of dairy product consumption is associated with significantly lower odds of hypertension among Chinese adults.
Diabetes was a major risk factor for numerous chronic diseases. However, the associations between daytime napping and diabetes in the existing literature is still inconsistent.
The analysis included ...53,916 participants aged 30-79 years of the China Kadoorie Biobank prospective study from Tongxiang. Incident diabetes were identified through linkage with incident diabetes surveillance systems, health insurance system, and death registries. Cox regressions were used to estimate the associations of daytime napping with diabetes.
5.11% of participants reported habitual daytime napping. During 488,233 person-years (median 9.4 years) of follow-up, 3333 incident diabetes, including 1249 males and 2084 females, were documented. After adjusting for socio-demographic status, behavioral lifestyle, BMI, waist circumference and snoring, as comparison with those without daytime napping, the hazard ratios for risk of diabetes were 1.39 (95% CI 1.21-1.59). The corresponding figures for males and females were 1.45 (95% CI 1.20-1.74) and 1.30 (95% CI 1.05-1.59), respectively. The corresponding figures for postmenopausal and premenopausal females were 1.41 (95% CI 1.08-1.80) and 1.13 (95% CI 0.78-1.59), respectively.
Habitual daytime napping is positively associated with risk of diabetes in adults, except premenopausal females.
Background: In an effort to provide greater financial protection from the risk of large medical expenditures, China has gradually added catastrophic medical insurance (CMI) to the various basic ...insurance schemes. Tongxiang, a rural county in Zhejiang province, China, has had CMI since 2000 for their employee insurance scheme, and since 2014 for their resident insurance scheme.
Methods: Compiling and analysing patient-level panel data over five years, we use a difference-in-difference approach to study the effect of the 2014 introduction of CMI for resident insurance beneficiaries in Tongxiang. In our study design, resident insurance beneficiaries are the treatment group, while employee insurance beneficiaries are the control group.
Findings: We find that availability of CMI significantly increases medical expenditures among resident insurance beneficiaries, including for both inpatient and outpatient spending. Despite the greater financial protection, out-of-pocket expenditures increased, in part because patients accessed treatment more often at higher-level hospitals.
Interpretation: Better financial coverage for catastrophic medical expenditures led to greater access and expenditures, not only for inpatient admissions—the category that most often leads to catastrophic expenditures—but for outpatient visits as well. These patterns of expenditure change with CMI may reflect both enhanced access to a patient's preferred site of care as well as the influence of incentives encouraging more care under fee-for-service payment.
Funding: Stanford University's Freeman Spogli Institute for International Studies’ Policy Implementation Lab and a Shorenstein Asia Pacific Research Center faculty research award provided funding for this project.
Chinese translation of the abstract (Appendix 1)
Health systems globally face increasing morbidity and mortality from chronic diseases, yet many - especially in low- and middle-income countries - lack strong chronic disease management in primary ...health care (PHC). We provide evidence on China’s efforts to promote PHC management using unique five-year panel data in a rural county, including health care utilization from medical claims and health outcomes from biomarkers. Utilizing plausibly exogenous variation in management intensity generated by administrative and geographic boundaries, we compare hypertension/diabetes patients in villages within two kilometers distance but managed by different townships. Results show that, compared to patients in townships with median management intensity, patients in high-intensity townships have 4.8% more PHC visits, 5.2% fewer specialist visits, 11.7% lower likelihood of having an inpatient admission, and 3.6% lower medical spending. They also tend to have better medication adherence and better control of blood pressure. The resource savings from avoided inpatient admissions substantially outweigh the costs of the program.
Stroke is the second leading cause of death worldwide and accounts for >2 million deaths annually in China
. Ischemic stroke (IS) and intracerebral hemorrhage (ICH) account for an equal number of ...deaths in China, despite a fourfold greater incidence of IS
. Stroke incidence and ICH proportion are higher in China than in Western populations
, despite having a lower mean low-density lipoprotein cholesterol (LDL-C) concentration. Observational studies reported weaker positive associations of LDL-C with IS than with coronary heart disease (CHD)
, but LDL-C-lowering trials demonstrated similar risk reductions for IS and CHD
. Mendelian randomization studies of LDL-C and IS have reported conflicting results
, and concerns about the excess risks of ICH associated with lowering LDL-C
may have prevented the more widespread use of statins in China. We examined the associations of biochemically measured lipids with stroke in a nested case-control study in the China Kadoorie Biobank (CKB) and compared the risks for both stroke types associated with equivalent differences in LDL-C in Mendelian randomization analyses. The results demonstrated positive associations of LDL-C with IS and equally strong inverse associations with ICH, which were confirmed by genetic analyses and LDL-C-lowering trials. Lowering LDL-C is still likely to have net benefit for the prevention of overall stroke and cardiovascular disease in China.
ObjectiveTo evaluate type 2 diabetes mellitus (T2DM)-related direct medical costs by complication type and complication number, and to assess the impacts of complications as well as socioeconomic ...factors on direct medical costs.DesignA cross-sectional study using data from the region’s diabetes management system, social security system and death registry system, 2015.SettingTongxiang, China.ParticipantsIndividuals diagnosed with T2DM in the local diabetes management system, and who had 2015 insurance claims in the social security system. Patients younger than 35 years and patients whose insurance type changed in the year 2015 were excluded.Main outcome measuresThe mean of direct medical costs by complication type and number, and the percentage increase of direct medical costs relative to a reference group, considering complications and socioeconomic factors.ResultsA total of 19 015 eligible individuals were identified. The total cost of patients with one complication was US$1399 at mean, compared with US$248 for patients without complications. The mean total cost for patients with 2 and 3+ complications was US$1705 and US$2994, respectively. After adjustment for socioeconomic confounders, patients with one complication had, respectively, 83.55% and 38.46% greater total costs for inpatient and outpatient services than did patients without complications. The presence of multiple complications was associated with a significant 44.55% adjusted increase in total outpatient costs, when compared with one complication. Acute complications, diabetic foot, stroke, ischaemic heart disease and diabetic nephropathy were the highest cost complications. Gender, age, education level, insurance type, T2DM duration and mortality were significantly associated with increased expenditures of T2DM.ConclusionsComplications significantly aggravated expenditures on T2DM. Specific kinds of complications and the presence of multiple complications are correlated with much higher expenditures. Proper management and the prevention of related complications are urgently needed to reduce the growing economic burden of diabetes.
Epidemiological evidence on the association of soy intake with breast cancer risk is still inconsistent due to different soy intake levels across previous studies and small number of breast cancer ...cases. We aimed to investigate this issue by analyzing data from the China Kadoorie Biobank (CKB) study and conducting a dose–response meta-analysis to integrate existing evidence. The CKB study included over 300,000 women aged 30–79 from 10 regions across China enrolled between 2004 and 2008, and followed-up for breast cancer events until 31 December 2016. Information on soy intake was collected from baseline, two resurveys and twelve 24-h dietary recalls. We also searched for relevant prospective cohort studies to do a dose–response meta-analysis. The mean (SD) soy intake was 9.4 (5.4) mg/day soy isoflavones among CKB women. During 10 years of follow-up, 2289 women developed breast cancers. The multivariable-adjusted relative risk was 1.00 (95% confidence interval CI 0.81–1.22) for the fourth (19.1 mg/day) versus the first (4.5 mg/day) soy isoflavone intake quartile. Meta-analysis of prospective studies found that each 10 mg/day increment in soy isoflavone intake was associated with a 3% (95% CI 1–5%) reduced risk of breast cancer. The CKB study demonstrated that moderate soy intake was not associated with breast cancer risk among Chinese women. Higher amount of soy intake might provide reasonable benefits for the prevention of breast cancer.
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